Middle Ear Complications Research Articles

Otomicroscopic and functional outcomes after cleft palate repair via Sommerlad intravelar veloplasty vs. modified Veau-Wardill-Kilner push-back.

We aim to compare the modified Veau-Wardill-Kilner push-back technique (VWK) and the Sommerlad intravelar veloplasty (Sommerlad IVVP) in terms of middle ear outcomes and oronasal fistulae frequency in three years old children. For this retrospective cohort study, data were collected and anonymized from consecutive patients with cleft palate (with or without cleft lip) who underwent surgery in our hospital between January 2008 and December 2018. Patients with syndromic diagnoses and patients who underwent surgical treatment elsewhere were excluded. We collected data from 101 children (202 ears) regarding middle ear complications at the age of three, including acute otitis media, middle ear effusion, tympanic membrane retraction, tympanic membrane perforation, tympanic membrane atelectasis and chronic otitis media with cholesteatoma. In addition, the presence of oronasal fistulae and the number of ventilation tubes received by the age of three were recorded. The odds of children having a normal middle ear evaluation were 3.07 (95% Confidence interval (95%CI): [1.52, 6.12]; p<0.05) times higher when children received Sommerlad IVVP compared to modified VWK. With 40.7% compared to 26.7%, a significantly higher incidence of middle ear effusion was present in the modified VWK group compared to Sommerlad IVVP (X2(1)=4.38, p<0.05). Furthermore, this group needed significantly more ventilation tube reinsertions (X2(2)=12.22, p<0.05) and was found to have a significantly higher incidence of oronasal fistula (53.5% vs. 17.2%, X2(1)=14.75, p<0.05). The latter was significantly associated with a higher need for ventilation tube reinsertion (X2(1)=7.34, p<0.05). This study shows superior middle ear outcomes and fewer oronasal fistulae after Sommerlad IVVP compared to modified Veau-Wardill-Kilner push-back at the age of three.

Risk of Middle Ear Complications in Intubated Patients on Mechanical Ventilation Versus Non Intubated

Patients on mechanical ventilation through artificial airway intubation may compromise their normal eustachian tube function and equilibration of middle ear pressures. Aim of the study is to evaluate the risk of middle ear complications in the positive pressure air-filled middle ears. A prospective study of patients findings with a different diagnosis, who were admitted for more than ten days duration in Intensive Care Units (ICU) in different hospitals of Benghazi city over a period of six months . Head injury and tympanic membrane rupture were excluded in this study. The approach that had been used was otoscope examination of the ears of 120 ICU patients by an ENT specialist, Results: (the age ranged from 14 days to 75 years). The comparison between two groups of intubated (40 cases) and non-intubated (80 cases) patients was performed. Among 40 mechanically ventilated patients, 37 patients (92.5%) developed middle ear complications. Whereas only nine out of 80 patients in non intubated group(11.3%) were developed middle ear complications. These results suggest that all intubated patients on mechanical ventilation for more than ten days should be routinely examined, and subjected for portable tympanometry evaluation of the middle ear. They may need tympanostomy tubes insertion.

Case Report: Case report: A rare case of middle-ear Rhabdomyosarcoma in a 4-year-old boy

We present a rare case of a four-year-old boy with a botyroid embryonal rhabdomyosarcoma of the right middle ear. Rhabdomyosarcoma is a soft tissue malignancy which is thought to originate from embryonic mesenchymal cells of striated skeletal muscle. It is a disease primarily of children and is exceptionally rare in parameningeal regions. The diagnosis is often delayed and easily misdiagnosed as aural polyp. Therefore, advanced disease is common at the time of diagnosis. A four-year-old boy presented with a four-month history of recurrent left ear blood and pus discharge, otalgia and fevers. He attended his GP three times and paediatric A&amp;E 13 times where he received antibiotics for presumed otitis media and externa. He was eventually referred to the otolaryngology department and underwent an examination under anaesthesia of ear and excisional biopsy of a suspicious aural polyp. Staging chest CT and PET scan showed no loco-regional spread or distal metastasis. Magnetic resonance imaging demonstrated absence of invasion into adjacent organs. Histology confirmed embryonal rhabdomyosarcoma, botryoid subtype. Subsequent to the initial excision of the polyp, he was started on an ifosfamine, vincristine and actinomycin (IVA) chemotherapy regime in three weekly cycles for nine cycles with concomitant radiotherapy. Two weeks subsequent to his first chemotherapy dose he presented with a House-Brackmann II-III facial nerve palsy but no other middle ear complications. He was started on intravenous antibiotics and dexamethasone. The facial nerve palsy incompletely resolved with treatment.

Assessment of eustachian tube dysfunction in middle ear pathologies

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Auditory tube dysfunction is suspected as primary cause of chronic otitis media and leads to surgical related complications in otitis media with tympanic membrane perforation. The diagnosis of eustachian tube malfunction is essential to know the pathogenesis of chronic otitis media.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total 150 cases and 75 age, sex matched control subjects between age group 20-50 years were selected. Pre and post-surgical history was noted and detailed ear examination, tympanometry was done. Auditory tube function was evaluated through Valsalva test, nasopharyngoscopy, pneumatic otoscopy. Intact tympanic membrane was assessed by Williams test, perforated tympanic membrane by Toynbee’s test. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Postoperative assessment of eustachian tube function by Toynbee’s test for 19 cases with failed tympanoplasty showed normal ET function in 5 cases, 8 cases had partial and 6 cases had gross ET dysfunction. Postoperative assessment ET function by William’s test showed 4 cases among 19 cases had partial ET dysfunction and 01 cases had gross ET dysfunction.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Efficient surgical outcome of middle ear complications always depends on eustachian tube function. Most of the cases with residual CP showed partial or gross ET dysfunction. Patients with tubal dysfunction should be evaluated for underlying cause and treatable causes should addressed before proceeding for surgery as it increases the success rate of tympanoplasty.&lt;/p&gt;

Irradiated ears in nasopharyngeal carcinoma survivors: A review.

This article reviews the literature on otological complications in nasopharyngeal carcinoma (NPC) survivals after irradiation during the past three decades. Symptoms of the irradiated ears were assessed from the external ear canal, through the middle ear cavity including the Eustachian tube, and to the inner ear compartments. The development of radioimaging diagnostic techniques, the introduction from adjuvant chemotherapy to concurrent chemoradiotherapy, and the invention of radiotherapeutic equipment to intensity-modulated radiotherapy (IMRT) have increased the survival rate of NPC patients during the past 30 years. The prevalence of cochlear and vestibular deficits has decreased a lot, whereas middle ear complications (i.e., otitis media with effusion and radiation-induced otitis media) do not decline in NPC survivors even in the IMRT era, probably because the medial half of the Eustachian tube receives > 95% of the total dose despite 2DRT or IMRT. Laryngoscope, 129:637-642, 2019.

Chronic inflammatory middle ear disease: Postoperative CT and MRI findings

AimTo prospectively evaluate the value of CT and MRI in diagnosis of middle ear pathologies following operation for chronic otitis media (COM). Patients and methodsFifty patients, who had been operated on for chronic middle ear disease, were referred for either CT alone or followed by MRI depending on the different case scenarios. Imaging findings were correlated with surgical findings. ResultsCT alone was done in 10 patients; 6/10 showed a free mastoidectomy cavity and 4/10 showed a clear cavity with abnormal position of the prosthesis. The rest of the 40 patients did a CT followed by MRI which showed granulation tissue in 17 patients, cholesteatoma in 13/14 patients of which one showed intracranial extension, combined granulation tissue with cholesteatoma in 5/6 patients, cholesterol granuloma in 2 patients and meningocele in another 2 patients. Overall CT sensitivity and specificity was 46.25% and 90.77% and MRI sensitivity and specificity was 95.23% and 99.16% respectively. ConclusionCT and MRI are both safe non-invasive diagnostic methods. Both procedures can provide radiologists a confident diagnosis of postoperative middle ear complications, assisting otologists with a provisional diagnosis for a better management.

Inner ear deficits in irradiated nasopharyngeal carcinoma survivors.

Despite the advancement of concurrent chemoradiotherapy, inner ear symptoms such as hearing loss, tinnitus, or vertigo/dizziness are still experienced in irradiated nasopharyngeal carcinoma (NPC) survivors. This study utilized an inner ear test battery to assess the causes and sequence of inner ear deficits in irradiated NPC survivors with a mean interval of 10 years after radiotherapy. Retrospective study. Thirty-six irradiated NPC survivors were enrolled. Otoscopy and an inner ear test battery comprising audiometry were performed, as well as ocular vestibular-evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests. Otoscopic examination revealed middle ear complications in 37 ears (51%), including radiation-induced otitis media in 32 ears and otitis media with effusion in five ears. Percentages of abnormal cVEMP test, oVEMP test, bone-conducted mean hearing level, and caloric test were 91%, 75%, 67%, and 39%, respectively, exhibiting a significantly declining sequence in inner ear deficits. Most (67%) NPC survivors had inner ear deficit originated from peripheral vestibular lesion, mainly due to sequela of otitis media. In contrast, 33% of them had inner ear deficit caused by central vestibular disorder. A significant sequential decline in inner ear function of irradiated NPC survivors was observed from the saccule to the utricle, cochlea, and semicircular canals. Most of them were due to sequela of otitis media, followed by central vestibular disorder. 4.

Alteration of distortion product otoacoustic emission input/output functions in subjects with a previous history of middle ear dysfunction

SummaryBackgroundThe aim of this study was to investigate the effects of sub-clinical alterations on the amplitudes and slopes of the DPOAE input-output responses from subjects with previous history of middle ear dysfunction.Material/MethodsThe study included 15 subjects with and 15 subjects without a history of otitis media in the last 10 years. All participants were assessed with acoustic immittance, pure-tone audiometry, and DPOAEs. For the later, I/O functions and I/O slopes were estimated at 1501, 2002, 3174, 4004 and 6384Hz.ResultsNo statistically significant differences were found between the 2 groups in terms of behavioral thresholds. The group with a previous history of middle ear dysfunction presented significantly lower mean DPOAE amplitudes at 2002, 3174 and 4004 Hz. In terms of DPOAE slopes, no statistically significant differences were observed at the tested frequencies, except at 3174 Hz.ConclusionsMiddle ear pathologies can produce subclinical alterations that are undetectable with traditional pure-tone audiometry. The data from the present study show that reduced amplitude DPOAEs are associated with a previous history of middle ear complications. The corresponding DPOAE slopes were affected at only 1 tested frequency, suggesting that the cochlear non-linearity is preserved. Considering these results, it remains to be elucidated to what degree the DPOAE amplitude attenuation interferes with higher-order auditory tasks.

Oto-Toxicity After Radiation Therapy of Head and Neck Cancers

Oto-Toxicity After Radiation Therapy of Head and Neck Cancers

Failure of grommet insertion in post-irradiation otitis media with effusion.

Nasopharyngeal carcinoma (NPC) survivors with post-irradiation otitis media with effusion (OME; 100 ears) were divided into 2 groups. One group underwent grommet insertion, and the other group was treated by repeated myringotomies plus aspiration to evaluate the outcome of the OME. Computed tomography, magnetic resonance imaging, audiometry, and local checks of the ear, nose, and nasopharyngeal fields were performed to evaluate the sinus and middle ear conditions over a long-term (more than 10 years) follow-up period. The results in these NPC survivors with OME indicated that the prevalence of middle ear complications in the myringotomized group (33%) was less than that in the grommeted group (90%). Grommets alone cannot eradicate inflammation outside the middle ear cavity, but rather, they can aggravate it by superinfection. We therefore recommend that controlling the radiation-induced inflammation in areas such as the ears, nose, sinuses, and nasopharynx is most important. In conclusion, post-irradiation OME should be treated in a different way from conventional OME. Restated, grommet insertion is contraindicated in post-irradiation OME.

Preservation of Tubal Function in Patients with Nasopharyngeal Carcinoma, Post-irradiation

Nineteen nasopharyngeal carcinoma (NPC) patients were subjected to eustachian tube function testing before and 5 years after irradiation. Tubal patency and clearance function of the eustachian tube showed deterioration if maximum irradiation dosage was more than 70 Gy, whereas dynamic function of the eustachian tube was preserved. Development of middle ear complications in NPC patients post-irradiation was caused by both tubal and inflammatory factors. To preserve tubal function, maximum irradiation dosage to NPC should be limited to 70 Gy. To decrease the inflammatory reaction, firstly, middle ear effusion should be drained by repeated myringotomies instead of grommet insertion, and secondly, sinusitis should be evaluated and treated, because sinusitis can aggravate otitis media with effusion.

A 10-year longitudinal study of tubal function in patients with nasopharyngeal carcinoma after irradiation.

To follow up the chronological change of tubal function in patients with nasopharyngeal carcinoma for 10 years after irradiation. Patients with nasopharyngeal carcinoma were subjected to eustachian tube function tests before irradiation and 6 months, 5 years, and 10 years after irradiation. University hospital. Ten patients (20 ears), 7 men and 3 women. Twelve (60%) of the ears had patulous tubes 10 years after irradiation, which might result from atrophy of peritubal tissues. The occurrence of a patulous tube was independent of the radiation dosage, but it was related to the interval since irradiation. Development of a patulous tube is associated with correction of organic obstruction of the eustachian tube. Resolution of the inflammatory reaction plays the most important role in recovery of function of the tube. Therefore, the prevalence of middle ear complications is low 10 years after irradiation.

Hyperbaric oxygen therapy: Effect on middle ear and eustachian tube function

Hyperbaric oxygen therapy (HBO) involves intermittent inhalation of 100% oxygen under a pressure greater than 1 atm. It is an important mode of adjuvant therapy for disease processes such as decompression sickness, osteomyelitis, carbon monoxide poisoning, and poorly healing wounds. Patients undergoing this therapy often complain of ear pain and/or fullness which can be transient or long standing. This prospective study objectively measured the changes in eustachian tube function before and after HBO treatment in 33 adult patients by the 9-step inflation-deflation test described by Bluestone. The results show 15 of the 33 patients (45%) had evidence of eustachian tube dysfunction after treatment was initiated. Of these, 15 (100%) developed the sensation of fullness, 13 (87%) developed serous otitis media, and 7 (47%) required tympanostomy tubes. The overall incidence of middle ear problems was 27 patients (82%) experiencing a sensation of fullness, 17 (52%) developing serous otitis media, and 8 (24%) requiring tympanostomy tubes. The middle ear complications reported in this study are much higher than those in previous reports in the literature. Twelve of 33 patients presented with a subjective history of eustachian tube dysfunction, and all 12 (100%) developed fullness in their ears and serous otitis media during the course of the treatment. The findings reveal that patients manifesting eustachian tube dysfunction after their first HBO treatment were at significantly greater risk toward developing symptoms of fullness and serous otitis media, often requiring tympanostomy tube placement. In addition, a history of eustachian tube dysfunction accurately predicted the development of fullness and serous otitis media.

The assessment of middle ear function and hearing by tympanometry in children before and after early cleft palate repair

Tympanometry has been carried out to assess middle ear function in cleft lip and cleft palate children from birth. All these children had normal aeration of the middle ear at birth, and remained normal until complications began to appear at 17 weeks. Closure of the palatal defect is known to reduce middle ear complications and its seems that closure at, or before, 4 months of age significantly reduces these complications.

Middle ear complications in clefts. Results of stage I in long-term studies of hearing defects, considering the type of cleft and the age of the patient

International Abstracts of Plastic and Reconstructive Surgery: Congenital Anomalies: Cleft Lip and Palate: PDF Only

Blowing a Wind Instrument

To the Editor:— Dr. Henry D. Friedman's letter to the editor ( JAMA 177 :276 [July 29] 1961) contained a false premise; that is, that blowing a wind instrument will cause increased pressure in the nasopharynx and thus produce a Valsalva maneuver. In blowing an instrument, the palate closes off the nasopharynx and thus the increased pressure is not transmitted to the eustachian tubes. As an oboe player and an otolaryngologist, I can speak from my own experience and believe that any concern over middle ear complications being caused by blowing an instrument during an upper respiratory infection is superfluous.

Effective control of postnasal hemorrhage.

The usual method of controlling epistaxis from the posterior nose is through use of a postnasal pack. Unfortunately, the postnasal pack has several serious disadvantages. First, it is exceedingly uncomfortable to the patient. Second, it commonly causes middleear complications. Third, postnasal packs are too often used as an expedient when a more careful examination might disclose bleeding from a site amenable to local packing. Recent articles by Hallberg, 1 Neivert, 2 and others emphasize the advantage of Postnasal packs which fit one choana only. Their packs are shaped so as to provide pressure in the posterior nose rather than in the nasopharynx, where a larger pack may obstruct the Eustachian tube. Directions and illustrations for the construction of packs accompany the articles. * Just as effective as the conventional postnasal pack and infinitely more pleasant is a small pack placed directly at the bleeding site. Fortunately, insofar as the use of

Some Experiences of the Operative Treatment of the Middle Ear Complications of the Exanthemata

Some Experiences of the Operative Treatment of the Middle Ear Complications of the Exanthemata